Resection Of Bronchogenic Cyst Research Articles

Uniportal Video-Assisted Thoracic Surgery in a Pediatric Hospital: Early Results and Review of the Literature

Background: Uniportal video-assisted thoracic surgery (U-VATS) is an implemented technique in adult surgery that may aid to extend offer the benefits of thoracoscopy to a wide number of pediatric patients. Materials and Methods: Consecutive cases treated between July 2019 and July 2021 were retrospectively analyzed. Simultaneously, a MEDLINE systematic search was conducted. Results: Twelve patients (median age 13 years, median weight 44.5 kg) underwent 4 major procedures (n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1 bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2 debridement for empyema). The median observed operative time was 77 minutes. We recorded one conversion to biportal VATS. No intraoperative complications or 30-day morbidity-mortality was reported. A rate of 40% adverse postoperative events was observed (Clavien-Dindo grade I-IVa). Visual analog scale for postoperative pain recorded a median value of 0 on days 1, 2, and 3. The systematic review provided 15 full-text articles reporting 76 pediatric interventions (4 major and 72 minor procedures); among them, 1 biportal conversion, 3 mild postoperative complications, and 1 redo surgery are presented. Conclusions: As emerged from the literature review, U-VATS remains scarcely adopted by pediatric surgeons. Its feasibility is supported by the four reported major lung resections plus the four cases added on by our series. Thanks to a more rapid learning curve over conventional VATS, the uniportal technique could be accessible to a wider number of centers.

INFECTED SIMULTANEOUS MEDIASTINAL BRONCHOGENIC CYST AND ESOPHAGEAL DUPLICATION CYST MASQUERADING AS A LUNG ABSCESS

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Bronchogenic and esophageal duplication cysts are rare but significant developmental anomalies. We present a case with both types of cyst in a single mass mimicking a lung abscess with a protracted treatment course. CASE PRESENTATION: A healthy 26-year-old female was admitted with onset of left sided pleuritic chest pain and fever over 24 hours. Her exam was remarkable for fever and tachycardia; she had elevated markers of infection. Computed tomography (CT) of chest revealed a well-demarcated cystic mass in the left hemithorax with an air-fluid level. She had no prior chest imaging and denied aspiration events or substance use. She was thought to have an intraparenchymal lung abscess, and underwent CT guided aspiration with the drainage of frank purulent material. Because of suspected intraparenchymal location no drain was placed. Fluid cultures and cytology were negative but her sputum grew mucoid pseudomonas aeruginosa, which was an atypical pathogen in this patient. She was treated with four weeks of intravenous cefepime, and two weeks of levofloxacin and metronidazole, with serial imaging. Pleuritic chest pain persisted despite regression of the lesion over a 10-month period (Figures 1-3); after which she underwent resection through a left video-assisted thoracic surgical approach. Intraoperatively, a large densely adherent inflammatory lesion was connected to the esophagus without intraluminal connection. Thick purulent fluid from the cyst was sent for culture and cytology, which were again negative. Pathology of the cystic mass was consistent with an esophageal duplication cyst (EC) (Figure 4B) with an additional noncommunicating bronchogenic cyst (BC) (Figure 4A). At 6months follow-up visit, she was doing well and free of symptoms. DISCUSSION: To our knowledge this is the first case report of de-novo infected dual BC/EC in an adult. Our case highlights the need for consideration of congenital cysts while working up lung abscesses. The diagnosis may be difficult without surgical resection, as characteristic imaging findings are missing in up to half of cases. 1There is likely a role for aspiration of the cyst for both diagnostic and therapeutic purposes, however efficacy and safety data are limited.2 The optimal timing of cyst resection is also not clear, especially in asymptomatic cysts. There is a minimal evidence to support universal surgical resection, though infected and symptomatic cysts will continue to need surgical intervention. 2,3 CONCLUSIONS: Infected congenital cysts can present a diagnostic and therapeutic challenge. Atypical presentations, and lack of improvement with appropriate therapy, are important clues to the diagnosis. REFERENCE #1: St-Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, Pagé A, Brisson J. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991; 52:6–13. REFERENCE #2: Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg. 2010 Nov; 11(5): 649-59. REFERENCE #3: Fievet L, Gossot D, de Lesquen H, Calabre C, Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection of bronchogenic cysts in symptomatic versus asymptomatic patients: an outcome analysis, The Annals of Thoracic Surgery (2020) DISCLOSURES: no disclosure on file for Gary Hochhheiser; No relevant relationships by Obieze Nwanna Nzewunwa, source=Web Response No relevant relationships by Edmund Sears, source=Web Response No relevant relationships by Hilamber Subba, source=Web Response

A case of PSVT that disappeared after resection of bronchogenic cyst

A case of PSVT that disappeared after resection of bronchogenic cyst

BRONCHOGENIC CYST: A TALE OF THE THIRD RECURRENCE

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Bronchogenic cysts (BCs) are singular congenital variances that surface early from anomalous budding of the maturing respiratory system between the 26th and 40th day of gestation (1). Most BCs are asymptomatic until they compress the surrounding structures. BCs are commonly seen in the mediastinum or intrapulmonary; with a previously reported prevalence of 1 per 42,000 and 1 per 68,000 admissions. They account for 50% to 60% of all mediastinal cysts. If incomplete resected, there is very high recurrence rate (2). We report a patient with second recurrence of mediastinal BC noted 18 years after initial drainage without resection. CASE PRESENTATION: A 57-year-old female with history of biopsy-proven BC with mediastinoscopy drainage followed by first recurrence treated with thoracoscopic drainage. Symptoms at presentation included three days of chest pain radiating between the scapula, associated with shortness of breath, low grade fever, and a dry cough. Vital signs were stable and lab-work was remarkable for WBC of 15.03 K/mm3 with 1% immature granulocytes. Chest x-ray showed a right paratracheal soft tissue density measuring 4.5 cm. Chest CT showed a large low-attenuation mass measuring 8 x 4.8 cm in the mediastinum region with 23 Hounsfield unit density (Image 1,2). Patient underwent video-assisted thoracoscopy converted to right thoracotomy for incision and drainage with sclerotherapy of the BC. Biopsy showed benign fibrous tissue with respiratory epithelium consistent with BC without atypia (Image 3). No growth was appreciated on stain and culture. Serial chest x-rays prior to discharge showed resolution of the soft tissue density. Improvement of respiratory symptoms upon surgery and treatment of community-acquired pneumonia with Rocephin 1gm IV QD and Azithromycin 500mg IV QD for five days. DISCUSSION: With the help of this case report we hope to shed light on the fact that symptomatic cysts should be resected either by thoracotomy or via video-assisted thoracoscopy (VAT) regardless of patient age, unless surgical risks are unacceptably high, as in our patient due to proximity of prominent vessels (3). Although many asymptomatic cases have been reported, a number of complications with BCs have been described, with infection being the most common followed by respiratory obstruction. While there has been a recent rise in the use of thoracoscopic techniques for resection of bronchogenic cysts in adults, one should not forget about patients with high surgical risks. The benefits of thoracoscopy drainage are decreased scarring, reduced pain, and shorter hospitalization (4). CONCLUSIONS: If incomplete resection or drainage is done, as seen in this patient, then residual mucosa should be treated by toxic agents or electrocautery (5). We propose serial imaging to monitor for recurrence when incomplete resection or drainage is done, as no current guidelines are present. Reference #1: 1) Reichelt O, Grieser T, Wunderlich H, Möller A, Schubert J. Bronchogenic cyst. A rare differential diagnosis of retroperitoneal tumors. Urol Int. 2000;64(4):216-219. Reference #2: 2) Limaïem F, Ayadi-Kaddour A, Djilani H, Kilani T, El Mezni F. Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 cases. Lung. 2008;186(1):55-61. Reference #3: 3) McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology. 2000;217(2):441-446. 4) Lee DH, Park CK, Kum DY, Kim JB, Hwang I. Clinical characteristics and management of intrathoracic bronchogenic cysts: a single center experience. Korean J Thorac Cardiovasc Surg. 2011;44(4):279-284. [5] Rice DC, Putnam JB. Recurrent bronchogenic cyst causing recurrent laryngeal nerve palsy. Eur J Cardiothorac Surg 2002;21:561–3. DISCLOSURES: No relevant relationships by Loui Abdelghani, source=Web Response No relevant relationships by Hesham Afify, source=Web Response No relevant relationships by George Alvarez, source=Web Response No relevant relationships by Manuel Carrazana, source=Web Response No relevant relationships by Maria Wallis-Crespo, source=Web Response

Resection of Bronchogenic Cysts in Symptomatic Versus Asymptomatic Patients: An Outcome Analysis

The natural evolution of bronchogenic cysts (BCs) is unpredictable. Although most surgeons agree that symptomatic BCs should be resected, questions remain regarding the optimal management of asymptomatic mediastinal cysts. We present a case series of BCs to compare patients who underwent preventive operation with those who underwent surgical procedure after symptom onset. This 15-year multicenter retrospective study included 114 patients (32 children and 82 adults). Data on clinical history, pathology, mean hospital stay,intraoperative and postoperative complications, and associated intraoperative procedures were analyzed separately for symptomatic and asymptomatic patients. A total of 53 asymptomatic patients (46.5%) were compared with 61 symptomatic patients (53.5%). There were significantly more adults in the symptomatic group than in the asymptomatic group (48 vs 34 patients, P < .05). A thoracoscopic approach was used in 88 patients (77%), with 7 conversions to thoracotomy (9%), all in symptomatic patients. There were significantly more additional procedures (20% vs 4%, P= .01) and more intraoperative complications (20% vs 4%, P= .01) in symptomatic patients, but postoperative complications between symptomatic and asymptomatic patients were similar. The postoperative length of stay was significantly longer in symptomatic patients (5.71 days vs 4 days, P < .001). Pathologic examination found significantly more inflammatory reactions in symptomatic patients. Early surgical management of BCs may be recommended to prevent symptomatic complications, which are unpredictable and whose management is more complicated in advanced BCs. Surgery can be performed with a thoracoscopic approach, which is easier and safer when the cyst is small and uncomplicated.

Video-assisted thoracic surgery for bronchogenic cysts: is this the surgical approach of choice?

Although there is no consensus on the management of bronchogenic cyst, most surgeons advocate early removal, even in asymptomatic patients. To evaluate the feasibility and safety of video-assisted thoracic surgery (VATS) in the management of bronchogenic cysts and long-term follow-up, a retrospective analysis was performed. From January 1995 to April 2013, we retrospectively reviewed the charts of 113 patients who underwent VATS resection of bronchogenic cysts in our institution. Resection of the bronchogenic cysts by VATS was initially performed in patients who had a cyst in the thoracic cavity and no evidence of severely dense adhesion to other organs or tissues on a CT scan. Also, patients with a history of previous thoracic surgeries, in addition to those with concomitant diseases requiring surgical treatment, were enrolled in our series. Operations were carried out using the conventional three-port technique and histological examinations confirmed the diagnosis of benign bronchogenic cyst containing a ciliated columnar epithelial lining. The median size of the cysts was 3.7 cm in their greatest diameter (range, 1-10 cm). One hundred and nine patients with bronchogenic cyst were resected completely by VATS. In 4 cases, VATS was converted to open thoracotomy or median sternotomy: major adhesion to the bronchus in 2, left innominate venous injury in 1 and repair of bronchial tear by surgery in 1. We identified 5 intraoperative complications of tracheobronchial tear, vascular injury and oesophageal laceration. The median operation time was 96.8 min (range, 15-320 min). There were no operative mortalities or major postoperative complications. Patients with VATS excision were discharged after a median of 3.7 days postoperatively. The long-term follow-up ranged from 1 to 11 years, with a median follow-up of 4.2 years. There were no late complications or recurrences. Considering the low conversion and complication rate, VATS was safe and effective in the resection of the bronchogenic cysts. The size and the location of cysts were not important considerations in selecting the surgical method. VATS excision should be considered the primary therapeutic option in the management of patients with bronchogenic cysts.

Left main bronchus rupture during video-assisted thoracoscopic surgery resection of a bronchogenic cyst

Video-assisted thoracoscopic surgery (VATS) is an approach to resection of bronchogenic cysts (BC) which is effective and viable. There may be complications as a result of pericystic adhesions to neighboring structures during dissection. This report describes an unusual case of an operative complication, the rupture of the main left bronchus. The initial VATS approach was converted into a right thoracotomy to remove the cyst and suture the bronchus once adequate exposure was obtained. Bronchus reconstruction failed and a few hours later, it was necessary to perform a left thoracotomy. A left pneumonectomy was required after the attempt to reconstruct the anastomosis was ruled out. The conclusion is that great care should be taken when using VATS approach for BC with adhesions.

Left main bronchus rupture during video-assisted thoracoscopic surgery resection of a bronchogenic cyst

Video-assisted thoracoscopic surgery (VATS) is an approach to resection of bronchogenic cysts (BC) which is effective and viable. There may be complications as a result of pericystic adhesions to neighboring structures during dissection. This report describes an unusual case of an operative complication, the rupture of the main left bronchus. The initial VATS approach was converted into a right thoracotomy to remove the cyst and suture the bronchus once adequate exposure was obtained. Bronchus reconstruction failed and a few hours later, it was necessary to perform a left thoracotomy. A left pneumonectomy was required after the attempt to reconstruct the anastomosis was ruled out. The conclusion is that great care should be taken when using VATS approach for BC with adhesions.

Congenital lobar emphysema: 30-year case series in two university hospitals

OBJECTIVE: To review the cases of patients with congenital lobar emphysema (CLE) submitted to surgical treatment at two university hospitals over a 30-year period. METHODS: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up. RESULTS: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years). All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those). No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months), and no late complications were observed. CONCLUSIONS: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.

Successful treatment of an intrathoracic bronchogenic cyst in a Holstein-Friesian calf

A 5-½-month-old female Holstein-Friesian calf was presented with a history of recurring ruminal tympany and poor development. The absence of lung sounds on the right hemithorax suggested a right-sided intrathoracic pathology. Radiography and computed tomography revealed a large thin-walled cavernous lesion with a gas-fluid interface which almost completely filled the right thoracic cavity. Fluid aspirated from the lesion was clear, yellowish and odorless. These findings led to the diagnosis of a bronchogenic cyst. Thoracotomy was performed under general anesthesia. The cyst strongly adhered to the adjacent lung tissue. After removal of the free wall, the adjacent lung tissue was sealed using surgical stapling instruments, and the non-removable part of the wall was curetted and rinsed. The intensive postoperative management included antibiotic therapy, oxygen supplementation and regional lidocaine infusion. Anti-inflammatory drugs were administered for further pain control. The calf recovered well and was released from the clinic on postoperative day 11. Intra- or extrathoracic bronchogenic cysts result from abnormal budding during the embryonic development of the tracheobronchial system. Successful treatment of this calf despite the size of the lesion and the invasive character of the surgical intervention indicates that resection of bronchogenic cysts in cattle may be an option for valuable animals.

Minimally invasive surgery of the lung: lung biopsy, treatment of spontaneous pneumothorax, and pulmonary resection

Thoracoscopy of pediatric patients has evolved from diagnostic lung biopsy to a myriad of both diagnostic and therapeutic procedures. In this chapter, we discuss those procedures related to the child's lung which are most commonly performed: lung biopsy; resection of bronchogenic cysts, pulmonary sequestrations, and pulmonary lobes; and the treatment of spontaneous pneumothorax.

Open vs thorascopic surgical management of bronchogenic cysts

The aim of this study was to compare the operative outcome in children undergoing open vs thoracoscopic resection of bronchogenic cysts. The medical records of children who underwent the resection of bronchogenic cysts from 1990 through 2000 were reviewed. Four cyst resections were performed by the open technique and five using a thoracoscopic procedure. The age of the patients, length of hospital stay, duration of drainage, operating time, and outcome were investigated. The mean age of patients undergoing the open procedure was 3 years and 3 months; the mean age for thoracoscopy patients was 7 years and 10 months (p < 0.05). The operating time for the open procedure was 70 +/- 25 min; for the laparoscopic procedure, it was 78 +/- 6 min (p, NS), except in one case with a main bronchial tail that required conversion (320 min). Duration of surgical drainage was 6.5 +/- 3 days for the open procedure and 2.5 +/- 1 days for the thoracoscopic one (p < 0.05). Hospital stay for open patients was 12 days +/- 0 days; it was 6 +/- 1.6 days for thoracoscopic patients (p < 0.01). There were no deaths. The thoracoscopic procedure failed once due to a main bronchial tail and had to be converted to an open procedure. Other early complications included a bronchopulmonary infection after an open cyst excision and an atelectasis after a thoracoscopic cyst excision. Late complications included one reoperation for incomplete excision in each of the two groups. Bronchogenic cyst resection can be performed safely. For complete treatment of these patients, total excision of the wall cyst is needed. In selected patients, the thoracoscopic procedure may decrease the duration of surgical drainage and length of hospital stay without increasing the operating time or MSK for complications.

Report of a Case of Video‐Assisted Thoracoscopic Resection of Bronchogenic Cyst Developed in the Aorto‐Pulmonary Window

We report the case of a 28-years-old male with a bronchogenic cyst developed in the aorto-pulmonary window. Left video-assisted thoracoscopy was performed and the cyst was removed intact and completely. Operative time was 48 minutes. The postoperative course was uneventful and the patient was discharged on the third postoperative day. We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully approached by video-assisted thoracoscopy. In the case of an intraparenchymal or complicated cyst, thoracoscopic resection can be technically difficult and hazardous, and open approach is preferable.

Bronchogenic cysts of the mediastinum

During a 25-year period 69 patients whose ages ranged from 1 day to 64 years were treated for bronchogenic cyst of the mediastinum. The male-to-female sex ratio was 1:0.76. The cysts were symptomatic in 63.7%, compressive in 43.4%, and life threatening in 2.8% of cases. Symptoms and signs of compression were more frequent in infants and children than in adults. Such symptoms and signs were more dependent on the location of the cyst than on its volume. The preoperative diagnosis was wrong in 16% of cases. The cysts were approached through thoracotomy in 67 cases, including one conversion from thoracoscopy, and through cervicotomy and mediastinoscopy in one case each. The cysts opened into the respiratory tract in five cases. No communication with the esophageal lumen was observed. The cystic contents were apparently infected in three cases, but samples remained sterile at culture. There was one hospital death caused by a centrally located compressive cyst that was undiagnosed at thoracotomy. The postoperative morbidity rate was 13.4%. There were no further symptoms after operation in children, but five adults reported continuing pain or dyspnea. Resection of bronchogenic cysts is recommended because of uncertainties in diagnosis and in evolution. (J T HORAC C ARDIOVASC S URG 1995; 109: 1003-10)